MOTHER TERESA WOMENS UNIVERSITY, KODAIKANAL

(A STATE UNIVERSITY)
CENTRE FOR WOMENS STUDIES
Photograph
with
Application for the Post of
Attestation
Research Assistant/ Professional
Assistant/

1.

Full Name (in BLOCK letters)

2.

(a) Age and Date of Birth

3.

(b) Place of Birth and District

Sex

4.

Name of the Father / Husband

5.

Nationality and Religion

6.

Community
(Certificates must be enclosed
for BC/BCM/ MBC/ DNC/ SC/
SCA/ ST)
Address for Communication

7.

OC

BC

BCM

Phone / Mobile:
e-mail id:

MB
C

DNC

SC

SCA

ST

8. (a) Educational Qualification

Programme
of Study

Name of the
Institution /
University

Major
Subject
(s)

Regular or
Distance or
University
System

Month
and
Year of
Passin
g

Class

% of
Marks
(exact- 2
decimals)

PG---------UG---------HSC
SSLC
Others, if
any

9.

Any other experience that can be

counted

10. Enclosures (in the following order):

i.
ii.
iii.
iv.
v.
vi.
vii.
viii.

First page of SSLC Book/ Transfer Certificate

HSC Mark Statement
Degree Certificates starting from Highest Degree
Mark Statements for PG/ M.Phil., Degree
Community Certificate, if applicable
Copies of Certificate(s) of Previous Employment, if applicable
Others

I, ----------------------------------------------------- hereby declare that the information given in this

form are true to the best of my knowledge and belief. I also understand that suppression of facts
or deliberate furnishing wrong information will entail summary rejection of application and, if
detected after appointment is made, lead to disciplinary action or termination of appointment.
Signature of Applicant

Place:
Date: